Individual
KEINESHA SHONTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 I ST NE, WASHINGTON, DC 20002-4340
(202) 427-8851
Mailing address
208 I ST NE FL 2, WASHINGTON, DC 20002-4340
(202) 427-8851
(202) 929-2833
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
ASW91203
CA
104100000X
Social Worker
Primary
LG200002832
DC
Other
Enumeration date
09/06/2017
Last updated
07/16/2024
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